BILL NUMBER: AB 689	CHAPTERED  10/10/99

	CHAPTER   831
	FILED WITH SECRETARY OF STATE   OCTOBER 10, 1999
	APPROVED BY GOVERNOR   OCTOBER 8, 1999
	PASSED THE ASSEMBLY   SEPTEMBER 9, 1999
	PASSED THE SENATE   SEPTEMBER 7, 1999
	AMENDED IN SENATE   AUGUST 19, 1999

INTRODUCED BY   Assembly Member Gallegos

                        FEBRUARY 23, 1999

   An act to amend Section 14132.47 of the Welfare and Institutions
Code, and to amend Section 111 of Chapter 310 of the Statutes of
1998, relating to health, making an appropriation therefor, and
declaring the urgency thereof, to take effect immediately.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 689, Gallegos.  Medi-Cal.
   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services.
   This bill would make nonsubstantive technical changes in these
provisions.
   Existing law establishes the Cigarette and Tobacco Products Surtax
Fund consisting of certain revenues that may only be appropriated
for certain purposes.
   This bill would appropriate the sum of $14,941,000 from that fund
to the department to fund the Breast Cancer Early Detection Program.

   The bill would declare that it is to take effect immediately as an
urgency statute.
   Appropriation:  yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 14132.47 of the Welfare and Institutions Code
is amended to read:
   14132.47.  (a) It is the intent of the Legislature to provide
local governmental agencies the choice of participating in either or
both of the Targeted Case Management (TCM) and Administrative
Claiming process programs at their option, subject to the
requirements of this section and Section 14132.44.
   (b) The department may contract with each participating local
governmental agency or each local educational consortium to assist
with the performance of administrative activities necessary for the
proper and efficient administration of the Medi-Cal program, pursuant
to Section 1396b(a) of Title 42 of the United States Code, Section
1903a of the federal Social Security Act, and this activity shall be
known as the Administrative Claiming process.
   (c) (1) As a condition for participation in the Administrative
Claiming process, each participating local governmental agency or
each local educational consortium shall, for the purpose of claiming
federal medicaid matching funds, enter into a contract with the
department and shall certify to the department the amount of local
governmental agency or each local educational consortium general
funds or any other funds allowed under federal law and regulation
expended on the allowable administrative activities.
   (2) The department shall deny the claim if it determines that the
certification is not adequately supported for purposes of federal
financial participation.
   (d) Each participating local governmental agency or local
educational consortium may subcontract with nongovernmental entities
to assist with the performance of administrative activities necessary
for the proper and efficient administration of the Medi-Cal program
under the conditions specified by the department in regulations.
   (e) Each Administrative Claiming process contract shall include a
requirement that each participating local governmental agency or each
local educational consortium submit a claiming plan in a manner that
shall be prescribed by the department in regulations, developed in
consultation with local governmental agencies.
   (f) The department shall require that each participating local
governmental agency or each local educational consortium certify to
the department both of the following:
   (1) The availability and expenditure of 100 percent of the
nonfederal share of the cost of performing Administrative Claiming
process activities.  The funds expended for this purpose shall be
from the local governmental agency's general fund or the general
funds of local educational agencies or from any other funds allowed
under federal law and regulation.
   (2) In each fiscal year that its expenditures represent costs that
are eligible for federal financial participation for that fiscal
year.  The department shall deny the claim if it determines that the
certification is not adequately supported for purposes of federal
financial participation.
   (g) (1) Notwithstanding any other provision of this section, the
state shall be held harmless, in accordance with paragraphs (2) and
(3), from any federal audit disallowance and interest resulting from
payments made to a participating local governmental agency or local
educational consortium pursuant to this section, less the amounts
already remitted to the state pursuant to subdivision (m) for the
disallowed claim.
   (2) To the extent that a federal audit disallowance and interest
results from a claim or claims for which any participating local
governmental agency or local educational consortium has received
reimbursement for Administrative Claiming process activities, the
department shall recoup from the local governmental agency or local
educational consortium that submitted the disallowed claim, through
offsets or by a direct billing, amounts equal to the amount of the
disallowance and interest, in that fiscal year, less the amounts
already remitted to the state pursuant to subdivision (m) for the
disallowed claim.  All subsequent claims submitted to the department
applicable to any previously disallowed administrative activity or
claim, may be held in abeyance, with no payment made, until the
federal disallowance issue is resolved.
   (3) Notwithstanding paragraph (2), to the extent that a federal
audit disallowance and interest results from a claim or claims for
which the participating local governmental agency or local
educational consortium has received reimbursement for Administrative
Claiming process activities performed by a nongovernmental entity
under contract with, and on behalf of, the participating local
governmental agency or local educational consortium, the department
shall be held harmless by that particular participating local
governmental agency or local educational consortium for 100 percent
of the amount of the federal audit disallowance and interest, less
the amounts already remitted to the state pursuant to subdivision (m)
for the disallowed claim.
   (h) The use of local matching funds required by this section shall
not create, lead to, or expand the health care funding obligations
or service obligations for current or future years for any
participating local governmental agency or local educational
consortium, except as required by this section or as may be required
by federal law.
   (i) The department shall deny any claim from a participating local
governmental agency or local educational consortium if the
department determines that the claim is not adequately supported in
accordance with criteria established pursuant to this subdivision and
implementing regulations before it forwards the claim for
reimbursement to the federal medicaid program.  In consultation with
local government agencies and local educational consortia, the
department shall adopt regulations that prescribe the requirements
for the submission and payment of claims for administrative
activities performed by each participating local governmental agency
and local educational consortium.
   (j) Administrative activities shall be those determined by the
department to be necessary for the proper and efficient
administration of the state's medicaid plan and shall be defined in
regulation.
   (k) If the department denies any claim submitted under this
section, the affected participating local governmental agency or
local educational consortium may, within 30 days after receipt of
written notice of the denial, request that the department reconsider
its action.  The participating local governmental agency or local
educational consortium may request a meeting with the director or his
or her designee within 30 days to present its concerns to the
department after the request is filed.  If the director or his or her
designee cannot meet, the department shall respond in writing
indicating the specific reasons for which the claim is out of
compliance to the participating local governmental agency or local
educational consortium in response to its appeal.  Thereafter, the
decision of the director shall be final.
   (l) Participating local governmental agencies or local educational
consortium may claim the actual costs of nonemergency, nonmedical
transportation of Medi-Cal eligibles to Medi-Cal covered services,
under guidelines established by the department, to the extent that
these costs are actually borne by the participating local
governmental agency or local educational consortium.  A local
educational consortium may only claim for nonemergency, nonmedical
transportation of Medi-Cal eligibles for Medi-Cal covered services,
through the Medi-Cal administrative activities program.  Medi-Cal
medical transportation services shall be claimed under the local
educational agency Medi-Cal billing option, pursuant to Section
14132.06.
   (m) (1) Each participating local governmental agency shall
contribute to the department a portion of the agency's general fund
that has been made available due to the coverage of administrative
activities described in this section under the Medi-Cal program.  The
contributed funds shall be reinvested in health services through the
Medi-Cal program.  The total contribution amount shall be equal to
331/3 percent of amounts made available under this section, but in no
case shall the contribution exceed twenty million dollars
($20,000,000) a fiscal year less the amount contributed pursuant to
subdivision (m) of Section 14132.44.  Beginning with the 1994-95
fiscal year, each local governmental agency's share of the total
contribution shall be determined by claims submitted and approved for
payment through January 1 of the following calendar year.  Claims
received and approved for payment after January 1 for dates of
service in the previous fiscal year shall be included in the
following year's calculation.  Each local governmental agency's share
of the contribution for the previous fiscal year shall be determined
no later than February 15 and shall be remitted to the state no
later than April 1 of each year.  The contribution amount shall be
paid from nonfederal, general fund revenues and shall be deposited in
the Administrative Claiming Fund for transfer to the Health Care
Deposit Fund.
   (2) Moneys received by the department pursuant to this subdivision
are hereby continuously appropriated to the department for support
of the Medi-Cal program, and the funds shall be administered in
accordance with procedures prescribed by the Department of Finance.
If not paid as provided in this section, the department may offset
payments due to each participating local governmental agency from the
state, not related to payments required to be made pursuant to this
section in order to recoup these funds for the Administrative
Claiming Fund.
   (3) This subdivision shall only apply to claims approved for the
1994-95 to 1997-98 fiscal years, inclusive.
   (n) As a condition of participation in the Administrative Claiming
process and in recognition of revenue generated to each
participating local governmental agency and each local educational
consortium in the Administrative Claiming process, each participating
local governmental agency and each local educational consortium
shall pay an annual participation fee through a mechanism agreed to
by the state and local governmental agencies and local educational
consortia, or, if no agreement is reached by August 1 of each year,
directly to the state.  The participation fee shall be used to cover
the cost of administering the Administrative Claiming process,
including, but not limited to, claims processing, technical
assistance, and monitoring.  The department shall determine and
report staffing requirements upon which projected costs will be
based.  The amount of the participation fee shall be based upon the
anticipated salaries, benefits, and operating expenses, to administer
the Administrative Claiming process and other costs related to that
process.
   (o) For the purposes of this section "participating local
governmental agency" means a county or chartered city under contract
with the department pursuant to subdivision (b).
   (p) For purposes of this section, "local educational agency" means
a local educational agency, as defined in subdivision (h) of Section
14132.06, that participates under the Administrative Claiming
process as a subcontractor to the local educational consortium in its
service region.
   (q) (1) For purposes of this section, "local educational
consortium" means a local agency that is one of the service regions
of the California County Superintendent Educational Services
Association.
   (2) Each local educational consortium shall contract with the
department pursuant to paragraph (1) of subdivision (c).
   (r) (1) Each participating local educational consortium shall be
responsible for the local educational agencies in its service region
that participate in the Administrative Claiming process.  This
responsibility includes, but is not limited to, the preparation and
submission of all administrative claiming plans, training of local
educational agency staff, overseeing the local educational agency
time survey process, and the submission of detailed quarterly
invoices on behalf of any participating local educational agency.
   (2) Each participating local educational consortium shall ensure
local educational agency compliance with all requirements of the
Administrative Claiming process established for local governmental
agencies.
   (3) Ninety days prior to the initial participation in the
Administrative Claiming process, each local educational consortium
shall notify the department of its intent to participate in the
process, and shall identify each local educational agency that will
be participating as its subcontractor.
   (s) (1) Each local educational agency that elects to participate
in the Administrative Claiming process shall submit claims through
its local educational consortium or through the local governmental
agency, but not both.
   (2) Each local educational agency participating as a subcontractor
to a local educational consortium shall comply with all requirements
of the Administrative Claiming process established for local
governmental agencies.
   (t) For the purposes of this section, a "nongovernmental entity"
does not include an entity or person administered by, affiliated
with, or employed by a participating local governmental agency or a
local educational consortium.
   (u) The requirements of subdivision (m) shall not apply to claims
for administrative activities, pursuant to the Administrative
Claiming process, performed by public health programs administered by
the state.
   (v) A participating local governmental agency or a local
educational consortium may charge an administrative fee to any entity
claiming Administrative Claiming through that agency.
   (w) The department shall continue to administer the Administrative
Claiming process in conformity with federal requirements.
   (x) The department shall provide technical assistance to all
participating local governmental agencies and local educational
consortia in order to maximize federal financial participation in the
Administrative Claiming process.
   (y) This section shall be applicable to Administrative Claiming
process activities performed, and to moneys paid to participating
local governmental agencies for those activities in the 1994-95
fiscal year and thereafter, and to local educational consortia in the
1998-99 fiscal year and thereafter.
  SEC. 2.  Section 111 of Chapter 310 of the Statutes of 1998 is
amended to read:
  Sec. 111.  (a) The sum of two million six hundred thousand dollars
($2,600,000) is hereby appropriated from the Proposition 98 Reversion
Account to a consortium of county offices of education, on a
one-time basis, for three-year grants, beginning with the 1998-99
fiscal year, for the purpose of supporting technical assistance and
focussed group training to teach school district personnel how to
maximize reimbursements of federal funds for Medi-Cal services and
case management.
   (b) (1) There is hereby created, for purposes of this section, a
technical advisory committee, which shall be composed of one
representative from each of the 11 school superintendent regions,
representatives from appropriate state departments and agencies,
representatives from various school health and social services
organizations, four members representing large school districts, four
members representing medium school districts, four members
representing small school districts, and representatives from various
parent and community services organizations.
   (2) Expenses for the technical advisory committee created pursuant
to paragraph (1) shall not exceed forty-five thousand dollars
($45,000) per year of the funds appropriated by this section.
   (c) For the purposes of making the computations required by
Section 8 of Article XVI of the California Constitution, the
appropriation made by subdivision (a) of Section 41202 of the
Education Code, for the 1997-98 fiscal year, and included within the
"total allocations to school districts and community college
districts from General Fund proceeds of taxes appropriated pursuant
to Article XVIIIB," as defined in subdivision (e) of Section 41202 of
the Education Code, for the 1997-98 fiscal year.
  SEC. 3.  The sum of fourteen million nine hundred forty-one
thousand dollars ($14,941,000) is hereby appropriated from the
Unallocated Account in the Cigarette and Tobacco Products Surtax
Fund, to the State Department of Health Services, for the purpose of
funding the Breast Cancer Early Detection Program, in augmentation of
Item 4260-111-0236 of the Budget Act of 1999 (Ch.  50, Stats. 1999).

  SEC. 4.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect.  The facts constituting the necessity are:
   In order to provide needed funding for the early detection of
breast cancer in the most expedient manner, it is necessary that this
act take effect immediately.
